Provider Demographics
NPI:1891033957
Name:PATEL, MITAL SUMANKUMAR (MD (ORTHOPAEDICS))
Entity Type:Individual
Prefix:DR
First Name:MITAL
Middle Name:SUMANKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD (ORTHOPAEDICS)
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:105 MILLS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4169
Mailing Address - Country:US
Mailing Address - Phone:505-426-3795
Mailing Address - Fax:505-425-2653
Practice Address - Street 1:105 MILLS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4169
Practice Address - Country:US
Practice Address - Phone:505-426-3795
Practice Address - Fax:505-425-2653
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WATR60434874207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891033957Medicaid
WA1891033957Medicaid